Site-dependent effects of experimental hypo- and hyperthyroidism on resident macrophages in extraocular muscles of rats: a quantitative immunohistochemical study

A musculoskeletal model of low grade connective tissue inflammation in patients with thyroid associated ophthalmopathy (TAO): the WOMED concept of lateral tension and its general implications in disease

Background

Low level connective tissue inflammation has been proposed to play a role in thyroid associated ophthalmopathy (TAO). The aim of this study was to investigate this postulate by a musculoskeletal approach together with biochemical parameters.

Methods

13 patients with TAO and 16 controls were examined. Erythrocyte levels of Zn, Cu, Ca²⁺, Mg, and Fe were determined. The musculoskeletal evaluation included observational data on body posture with emphasis on the orbit-head region. The angular foot position in the frontal plane was quantified following gait observation. The axial orientation of the legs and feet was evaluated in an unloaded supine position. Functional propioceptive tests based on stretch stimuli were done by using foot inversion and foot rotation.

Results

Alterations in the control group included neck tilt in 3 cases, asymmetrical foot angle during gait in 2, and a reaction to foot inversion in 5 cases. TAO patients presented facial asymmetry with displaced eye fissure inclination (mean 9.1°) as well as tilted head-on-neck position (mean 5.7°). A further asymmetry feature was external rotation of the legs and feet (mean 27°). Both foot inversion as well as foot rotation induced a condition of neuromuscular deficit. This condition could be regulated by gentle acupressure either on the lateral abdomen or the lateral ankle at the acupuncture points gall bladder 26 or bladder 62, respectively. In 5 patients, foot rotation produced a phenomenon of moving toes in the contra lateral foot. In addition foot rotation was accompanied by an audible tendon snapping. Lower erythrocyte Zn levels and altered correlations between Ca²⁺, Mg, and Fe were found in TAO.

Conclusion

This whole body observational study has revealed axial deviations and body asymmetry as well as the phenomenon of moving toes in TAO. The most common finding was an arch-like displacement of the body, i.e. eccentric position, with foot inversion and head tilt to the contra lateral side and tendon snapping. We propose that eccentric muscle action over time can be the basis for a low grade inflammatory condition. The general implications of this model and its relations to Zn and Se will be discussed.

Macrophages and dendritic cells in normal and regenerating murine skeletal muscle

Mononuclear phagocytes and MHC class II+ dendritic cells (DC) were identified in frozen sections of skeletal muscle using a panel of pan-specific antimacrophage (MOMA-2, SER-4, Mac-1, F4/80), anti-major histocompatibility complex (MHC) class II (M5/114) and anti-DC (NLDC-145, N418, M342) monoclonal antibodies. Uninjured and regenerating skeletal muscle were investigated in SJL/J and BALB/c mice, strains with known differences in muscle regenerative capacity. Resident tissue macrophages and MHC class II+ DC were present within uninjured mouse muscle. A subpopulation of DC were positive for the pan-DC markers, N418 and M342, and negative for the lymphoid DC marker NLDC-145. Following crush injury, the macrophage population increased by day 2, became marked by day 3, and had decreased by day 6. In contrast, the number of MHC class II+ cells around the injury site increased steadily after injury and remained high at day 6. The numbers of macrophages and DC detected by immunohistochemical staining were consistently higher in SJL/J than BALB/c muscles. This study confirms that macrophages are a significant component of normal murine skeletal muscle and that these cells increase dramatically after injury. Furthermore the data also reveal for the first time that DC are present in normal skeletal muscle and that MHC class II+ cells, including DC, increase after injury. The presence of DC in muscle has important implications for the understanding of the immunobiology of muscle and immune-mediated processes such as the host versus graft responses following muscle transplants and autoimmune diseases affecting this tissue.

Effect of hypo- and hyperthyroidism on the function and metabolism of macrophages in rats

The effect of thyroid hormones on monocyte migration, phagocytic capacity and hydrogen peroxide production by macrophages and the effect of these hormones on glutamine and glucose metabolism was investigated. The experiments were performed on resident, thioglycollate- and BCG-stimulated cells from hypo- and hyperthyroid rats. High plasma levels of thyroid hormones suppressed the migration of monocytes and hydrogen peroxide production, whereas hypothyroidism did not affect cell migration but raised the phagocytic capacity and the hydrogen peroxide production. Hyperthyroidism increased the activities of glutaminase and hexokinase and the rates of decarboxylation of [U-14C]-glutamine and [U-14C]-glucose in inflammatory and activated cells. Hypothyroidism stimulated glucose metabolism and had only a slight effect on glutaminolysis. The activity of the TCA cycle was, however, diminished in the presence of high plasma levels of thyroid hormones and enhanced by the hypothyroid state. These findings suggest that the functional changes are more likely to be related to the activity of the TCA cycle rather than to glutaminolysis and glycolysis.